Select Committee on Home Affairs Minutes of Evidence

Examination of Witness (Questions 623 - 639)




  623. Good morning ladies and gentlemen. This is the latest of our evidence sessions in our inquiry into the drugs policy and whether it is working or not. We have received over 170 submissions, many of them have been flatly contradictory and we are therefore seeking the help of experts like Mr Trace to help us pick our way through them. For the record can you state what your present position is and what your past one was?

  (Mr Trace) I am currently the Director of Performance at the National Treatment Agency, a special health authority. I am the Chair of the Board of the European Monitoring Centre on Drugs and Drug Addiction. My past role from October 1997 until June 2001 was Deputy UK Anti-Drugs Co-ordinator.

  624. You have worked in the field of drugs policy for some years, is that right?
  (Mr Trace) Drugs treatment. The Deputy Drugs Czar role was the first policy role I had, although I was on various committees before. I was a drug treatment practitioner for some 12 years before that.

David Winnick

  625. Would you say that the Government's current drug policy is a success?
  (Mr Trace) By the Government's current drugs policy, I presume you mean the ten-year document Tackling Drugs to Build a Better Britain.

  626. Yes.
  (Mr Trace) I am sorry I cannot give you a straight answer but it is yes and no. There are elements of that strategy which I am very proud of and I think are working very well. There are elements which are not achieving the progress that we had hoped to achieve when we set out the strategy in 1998. My overall assessment would be very good progress in some areas, the fact that the strategy is bedded into government policy is a success in itself, but there are areas where I would have to say, being an architect of the strategy, I am disappointed in progress.

  627. Apart from wanting your view, I asked because in your paper, which I found very informative indeed, you seem very pessimistic about the reduction in young people's use of drugs. You wrote, "The reality of the last three years is that more and more young people are using cocaine as part of their social scene". If you had to hazard some sort of guess, how many more in percentage terms?
  (Mr Trace) Trying to reduce prevalence—and the target is to reduce prevalence by 50 per cent over the ten years of the strategy—is the area where evidence over the two to three years of implementation at the moment is showing that it is not working or not moving in the direction we want it to. We went for a very significant prevalence reduction because we thought that was one of the important things Government should be trying to achieve. The reality of what has happened over the last few years is that Britain as a high prevalence country—in European terms we are a high prevalence country of overall drug use—we have largely stabilised. After the increases we experienced through the 1980s and 1990s of cannabis use and recreational drug use such as ecstasy and amphetamines we have stabilised whereas there are quite large increases in other European countries, but we are still the highest prevalence country in Europe according to the surveys which are carried out by the Monitoring Centre. The percentage increases are actually quite marginal. There are different surveys which lead to conclusions that there are slight increases in overall drug use and slight increases in heroin use. The only significant statistical increase in my interpretation of the figures is amongst cocaine use by young people. I say in my written evidence, that I think that is largely linked to the increase in the youth culture's acceptance of cocaine use as part of a weekend lifestyle. That is where that blip is coming. I expect that to be the major prevalence problem, a very intractable prevalence problem for the drug strategy in the coming years. I also say in my evidence that I do not think some of the overall continuing high prevalence of drug use in terms of cannabis use which is the main driver of those figures is as major a public policy issue as issues such as cocaine and heroin. I think cocaine is the main prevalence problem we have at the moment.

  628. All those involved in the controversy over drugs, including those who want a more liberal legislation argue that nevertheless we should do our utmost to reduce the use of drugs and therefore there should be the maximum amount of education in secondary schools, perhaps even primary schools, warning of the dangers. You write, "While good drug education in schools, and investments in programmes for marginalised kids may be a good thing in their own right, they are unlikely to have an impact on the overall prevalence of youth drug use, and will certainly not get anywhere near the target of a 50% reduction". In your view why is it that despite what is happening in schools and the warnings and the rest of it about what is likely to happen with drug use, certainly excessive drug use of certain types of drugs which are dangerous, it is not having an effect?
  (Mr Trace) The truthful answer is that I am not entirely sure. The quality of what is being done in our schools in our drugs prevention has increased greatly over the last five to ten years and I should like to think particularly in the last few years since our strategy was brought in. There is good evaluation of some of this work to show that procedurally it is very good work, educationally it meets very high quality standards and that there are good outputs from that work inasmuch as young people are better educated, they are more knowledgeable about drugs, they have better health information with which to protect themselves. I am not entirely sure why that does not lead to more of them deciding not to use drugs, but through the surveys it certainly seems to be the case. I could hazard a guess for you. I would say that more and more young people, as youth culture develops generally, more and more young people are risk takers by nature. They are quite happy with a certain level of risk in their lives and they are quite happy that drug taking is part of the general growing up risk they take. It is becoming more normalised. That is a guess. I could not absolutely say to you that that is actually happening out there, but that is a social process which is going on. It is very hard for the state to turn back. It is absolutely right we should be investing in prevention activities and education activities around drugs. The only thing I say in my evidence and I say now is that we should not rely on that to achieve significant reductions in prevalence which is what we set out to do in 1998.

  629. Is it a social class division here? Would there be any equity in that kids in schools in areas of social deprivation and the rest are more likely to be prone to it than say at some public schools or other schools of academic excellence in the public sector?
  (Mr Trace) In terms of overall prevalence I do not think there is a significant difference. One social process which has happened over the 1990s is that drug culture and the various behaviours that go along with drug culture, have embedded themselves into working class culture just as much as they have into middle class culture. That obviously has an effect on the numbers we are talking about and that is not a reversible trend. I do not think we can change that; once it has happened, it has happened. There are other countries in Europe and other parts of the world which have not gone through that process, so their prevalence rates do not show the same pattern. The big difference in terms of social class or different types of schools is in terms of the problem drug use we associate with social exclusion. The main policy priority in the drug policy, and it is in the 1998 document, is the extent to which young people get involved in addictive or problematic patterns of drug use which are mostly associated with heroin and cocaine. That definitely is bedded much deeper into poor and working class communities than it is in middle or upper class communities.

  630. Is there a sort of daring? Could a comparison be made with cigarette smoking, obviously not to the same extent, but as we know, youngsters growing up like to smoke when they are under age. Is there a possibility that because drugs are illegal, there is a sort of daringness about it or would that be an exaggeration?
  (Mr Trace) It could work either way. There are surveys which would lead one to either conclusion. If you do surveys of young people and ask them why they use drugs or do not use drugs, very few of them say they did it because it made them look adult or they did it because it showed them to be daring. Quite a few who do not use drugs mention the fact that they are illegal as a reason not to use drugs. The legal status is relevant to some of those people's decision. I have to say it is not the majority or anywhere near the majority, but it is referred to by young people as an aspect in their decision making. It comes way below the health risk. Health risk tends to come top, attitude of parents comes next, not necessarily whether the parents are supportive or going to kick them out or anything, but it is whether their parents will find out and approve. Those at the two high ones, but the legal status does figure in there. On the other side, in my understanding of youth culture, and it is some time since I was part of it, this issue of trying out something which is slightly beyond the pale is absolutely an essential part of youth culture—"essential" is perhaps not the best word to use. Young people do want to try out things they see as adult or a bit dangerous. As with tobacco smoking, twelve-year-olds think tobacco smoking makes them look like fifteen-year-olds, fifteen-year-olds think cannabis smoking makes them look like eighteen-year-olds. That happens in youth culture in my view.

  631. Something which is forbidden and there is some satisfaction in breaking the taboos.
  (Mr Trace) Yes. We would not put figures on that or draw it as a causal link, but I do think that process happens in young people's minds.

  632. You say that the structured approach of the UK strategy has been seen as a model by the international community, which has been followed by a number of other countries. Why should that be so? After all, it could hardly be said that our policy is so successful that other countries should follow us.
  (Mr Trace) Absolutely. There was a statement by one of your members in one of the previous sessions which referred to the operation being a success but the patient being dead. That came home quite strongly to me. The dilemma for many years in drug policy, either national, global or European, has been that until the mid-1990s nobody had made a serious attempt to bring together all the complex strands of how drugs affect a western society and bring together all these issues of how you link up your education work to your treatment work, how you link up your social inclusion policy to your drugs policy, how you link the supply-side efforts with the demand-side efforts. Truly in my view, and somebody may prove me wrong with an historical document, the UK drug strategy of 1998 was the most sophisticated attempt to bring all those strands together, identify what the overarching objectives were and bring all of that morass of activities together into a government programme. That did have a very big impact in things like United Nations, the European Union. Many other countries, very quickly because they were looking also for solutions to this same issue, latched onto that as a way of going about writing a drug policy. My claims for its value are mainly in terms of giving people a structure by which to consider some very complex issues rather than its outcome success. There are two areas where we can claim outcome success but certainly not across the board.

  633. Are we as a country better, worse or much the same as other Western European countries when it comes to the drug scene? Are there more drugs here than elsewhere?
  (Mr Trace) What aspect are you asking about, the prevalence of use?

  634. Yes, of actual use.
  (Mr Trace) In terms of prevalence of use we are the highest prevalence country in Europe.

  635. Of all countries in Europe?
  (Mr Trace) Yes, of all countries in Western Europe. The way we measure this is that we do annual or biannual surveys of all people. We have a youth survey which is done with schoolchildren and we have a survey as part of the British Crime Survey which asks people a regular set of questions which are now international norms. We ask people whether they have used certain drugs ever, whether they have used certain drugs in the last 12 months and whether they have used certain drugs in the last month. We have a series of those surveys since the mid-1990s in many countries of Europe and consistently the UK comes first and consistently I have to sit in front of a press conference at the European Monitoring Centre and answer all the questions about Britain being the worst and so on. That is on overall drug prevalence, the number of people who report they have ever used these drugs. When you look at use last month you are basically reporting on the number of people who are current users of drugs and there is a big difference. Of all the people who have ever used drugs, the vast majority of them are not current users now. On both indicators the UK comes top of the European league. There may be six or seven other countries which are the same sort of level as us in overall prevalence, countries such as France, Spain, Portugal, Denmark and Holland, but three or four per cent below on most of these indicators; the same sort of broad picture but they are consistently just below us. Then there are several countries like Sweden or Finland who have very low prevalence rates.

  636. Can you give any explanation why we should be top of the league? It is top of the sort of league where hopefully most people would not wish to see us. Why Britain?
  (Mr Trace) Culture. I was going to say geography, but that would not explain an awful lot of it. Youth culture. If you think about British youth culture, cannabis became embedded into youth culture much earlier than it did in most other European countries and the big growth of drug use and the normalisation of drug use happened in the UK in the late 1980s with the changes in youth culture then. It just hit the UK much earlier than it hit most other countries. The most similar history of youth culture we have in any other European country is Holland, which does have broadly similar prevalence rates to us; slightly lower but broadly similar historical growth of drug use. Doing European comparisons always makes us look bad, but we do have lower prevalence rates than the US and Australia. We are not the worst in the world. One very important part of my written evidence is that using overall prevalence as the main indicator of the success of a drug strategy is the fundamental flaw in what we did in 1998. I do not think that overall prevalence is your best indicator of the harm being caused to a society by the use of drugs.


  637. What is the best indicator?
  (Mr Trace) There are three or four and we have failed to define a couple of them which is a real shame. The four indicators I really think we should be going for relate to the consequential harm of the use of drugs. They are: drug-related crime—we have that in the strategy; drug-related public health damage and there are two sub-indicators in there which would be overdose deaths and infections of HIV and hepatitis; drug-related social exclusion. I have referred to the last one in my written evidence. I think that is the most important thing we should be concentrating on in our drug policy, but because it is so amorphous and because it is so hard to develop a pure research indicator on it, it has not been one of the headlines of the drug strategy and that has been a real difficulty. What a country should be trying to achieve is to minimise those four harms rather than looking at the overall prevalence rate.

  Chairman: We shall expand on that in a moment.

  Mr Prosser

  638. Sticking with prevalence. When other witnesses have come before the Committee, people who are driving the present drug strategy, people like Keith Hellawell, Home Office Ministers, etcetera, and we have asked them whether the policy was working, you might have expected them to say it is working. When we press them on the issues we have pressed this morning and show them the record they use as a defence that it is only three years into a ten-year strategy and it will all be all right in the end. They do not quite say that, but that is the sort of view they give. Even when we press them harder on their expectation of meeting the targets, even the 50 per cent target, they are cautiously optimistic. Why do you take such a different view? Is it because you are not now part of that strategy? Before you left your last appointment, did you try to convince your colleagues and Ministers that some of the targets were perhaps wrongly set and that some of the strategy should be implemented in different ways?
  (Mr Trace) To answer your difficult question first, I am rather freer to speak now but I still work for the Government; I work for the Department of Health. To answer the next part of your question, broadly I have sympathy with that view. One of the very important things we said, which I regret that most of the press and particularly most of the House, do not seem to have remembered, was that anybody who promises to turn around the role of drugs and the use of drugs in society in a parliamentary term is lying. We said that in 1998. You do not change these basic social processes in two to three years. So I do have some sympathy with their position, "Give it time". I also have some sympathy with the position that the drug strategy is generally the right framework to follow through these actions. It is a very strong managerial framework, it has all the government departments signed up to it, has all the Ministers signed up to it. That is very important and you do not want to pull that apart. Where I have diverged is to say that I absolutely agreed in 1998 that we should be setting a very ambitious target to reduce prevalence. Why have a drug strategy if you are not intending to change things? All I am saying is that over three to four years we have to look at the evidence which is developing and my look at the evidence which is developing is that we should be much more pessimistic about that side of the strategy. That is all I am saying. I am not saying the strategy is wrong or failing. I am saying that on that issue, reducing prevalence, the actions we have put in place over the last few years are not having an impact yet. You could respond to that reality two ways. You could say stick with it, give it a few more years and see how it goes, or you could say that you need to think again and you need to approach this a bit differently. I am tending to the latter. I think it is still valid. There is no proof to say that to stick with that as a target is wrong, but I am tending to pessimism at the moment.

  639. On the question of prevalence, you made the point that it should not be one of the targets. How would you advise us? We would have to prepare the public for that story, would we not? If we said we now do not look upon prevalence as the main issue it is all about harm reduction, etcetera, and I have some sympathy with that, how would we prepare the ground in terms of public perceptions?
  (Mr Trace) I am not arguing to remove it as a target. What I am saying is prevalence is not the main thing we should be trying to achieve; a reduction in prevalence is not the main thing we should be trying to achieve. It still is a key indicator; obviously we need to know how many people are using drugs. Where I worry is about the allocation of resources. Target setting in government has a large impact on how resources are prioritised. If there is a key manifesto target or a key government strategy target, then it is going to attract resources. Where it starts to get difficult and over-prioritising the prevalence issues you find that the resources will go towards trying to achieve that target. It is a matter of resource allocation and balance of resource allocation in my view. Within the available resources we should be concentrating much more on programmes which reduce public health damage and programmes which reduce social exclusion. I am not really asking for a radical re-think of the strategy. The strategy is broadly the right framework. I am asking for a different prioritisation of resource allocation.

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